[firecracker123]

Ok, my husband brought home the package we will have for benefits. Coming from a country where health care (and in some cases dental) is free (ook, NOT FREE we pay out of our nose in taxes) I was concerned about what to look for. I also thought that I would do all the things up here (max the orthodontic limit for my son, all get physicals, eyes checked, prescription repeats filled, etc)....However, it looks really good, but not sure...what in general constitutes a decent benefits pacakage?

[sugarbeet]

There is so much variation among health care benefits, it's really hard to say. Even year to year changes with the same employer can be confusing and frustrating.

The best health care package I've had has included the following:

- No monthly premium for employee (but I've never heard of one that didn't have some premium for a family plan - less than $100 per month for family would be very good)

- $0 for regular dental check up/cleaning every six months

- $20 copay for doctor's visits

- $20 for brand name prescriptions/$5 for generic

- eligible to put up to $5k per year in flexible spending account

However, it sounds like your husband is working in the automotive industry, so I would guess your plan may even be better than that.

[Coldjensens]

Watch for plans with no individual or family out of pocket maximum. This is bad.

Without a maximum, you can be responsible for a portion of all charges no matter how much. Our daughter had major surgery when she was 8 months old and the charges totaled $380,000. we had an HMO that covered it all at the time, but under our present plan, we would be responsible for 40% of that.


If you get dental, vision and psychiatric care coverage, you are lucky. Not many businesses provide this coverage anymore.

Read the prescription coverage carefully. Some policies only cover generic drugs when available and some generic drugs do not work (thyroid medicine is one example). Some policies only cover 30 days worth of recurring medication in order to force you to pay the co-pay at least once a month. In some cases, buying in bulk with no insurance will cost the same or less than buying monthly with a $40 copay.


Insurance coverage is extremely complicated. It will give you a headache. You have Traditional insurance, PPOs, HMOs, and several new types of insurance. We are currently considering a type of reverse insurance where they cover the first $1000 at 100%, we then have to pay 100% of the next $2000, and then they pay anything over that. There is a family yearly maximum of $6000. It is pricey insurance, but you are protected for what insurance is intended to cover - catastrophic illness.

In one way you are fortunate. Health care in Michigan is much better than in many other states.

I am not sure why that is, but I suspect that it has to do with the obligation to provide free care for millions of illegal aliens in many other states.

[Coldjensens]

I forgot to add that it is often difficult to meet the deductible. We have a $1500 deductible, but the $40 copay for office visits does not count towards the deductible. You get charged $40 copay for each company that has anything to do with your care (thus, $40, for the doctor, $40 for the lab, $40 for the pharmacy). Further, of the other charges that you pay, the insurance company counts only the part of those charges that they feel are "reasonable". I paid $300 for stitches at an urgent care center, but the insurance company thought that the reasonable charge was $75.00. Thus, only $75.00 counted toward the $1500 deductible, even though I paid $300.

Further, you will get unexplained bills from all kinds of different companies all demanding that you pay them. Sometimes you will get bills that are for treatment that occurred 6 to 8 months earlier. Eventually the insurance will pay most of these bills, but you have to make certain that the insurance pays in time, or you will end up with your credit rating damaged.


See why it gives you a headache? However physical illness caused by stress created by insurance companies is not covered.

[firecracker123]

oh boy -- I didn't realize...I know that even up here the benefits plans differ, but because health care and eye care check ups is covered via taxes I don't worry too much about the others (dental is 90%, other than surgery/ortho which is 50% and prescriptions is 100% for most)

A quick look with your info tells me it's pretty good...but I'll still ensure we get checkups (with blood work etc) done here and have my son get his braces on here to maximize our limit. That way we can start a new limit for him (retainer plus spacer equals pretty darn close lol)

I would expect that I can visit with my husband's HR/Benefits associate to help explain it better?

[Coldjensens]

Absolutely get his braces done. You are looking at $5000 here and I have not heard of any insurance covering braces. They consider it cosmetic and all policies exclude cosmetic surgery unless there is a medical necessity for it.

Your HR person should be able to explain it, but you have to ask the right questions. Some of them are better than others. If you husband is a top level exec. I would expect that they have a pretty good HR/benefits person available.

[sugarbeet]

I have what I consider to be a very average dental plan and they cover 50% of the cost of braces for children under age 19. Plus, the balance can be paid with pre-tax money from the flexible spending account.

Firecracker - you definitely want to look into the flexible spending account. It lets you pay medical expenses (even for over-the-counter meds like aspirin, etc.) with pre-tax dollars.

Your husband's company's HR person should be able to explain all of the details to you.

[Coldjensens]

Our firm calls that account a Cafeteria plan. The only downside is that you have to use up all the money that you put into that account each year or you lose it. You determine a set amount to deposit each month, and then you have to use it all up by December 31.

You pay the medical bills or day care costs and then you get reimbursed from the account. It can be a huge tax savings, especially if you have full time day care. I am not sure if this is one of the deductions that gets eaten up by the alternative minimum tax. Check with your accountant.

You can also use cafeteria plan money to pay for day care if you both work.